The effect of transfusion of blood products on ventricular assist device support outcomes

Supriya Shore; Thomas C. Hanff; Jeremy A. Mazurek; Matthew Seigerman; Robert Zhang; Edward W. Grandin; Esther Vorovich; Paul Mather; Caroline Olt; Jessica Howard; Joyce Wald; Michael A. Acker; Lee R. Goldberg; Pavan Atluri; Kenneth B. Margulies; J. Eduardo Rame; Edo Y. Birati

doi:10.1002/ehf2.12780

The effect of transfusion of blood products on ventricular assist device support outcomes

Supriya Shore, Thomas C. Hanff, Jeremy A. Mazurek, Matthew Seigerman, Robert Zhang, Edward W. Grandin, Esther Vorovich, Paul Mather, Caroline Olt, Jessica Howard, Joyce Wald, Michael A. Acker, Lee R. Goldberg, Pavan Atluri, Kenneth B. Margulies, J. Eduardo Rame, Edo Y. Birati^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Aims: Perioperative blood transfusions are common among patients undergoing left ventricular assist device (LVAD) implantation. The association between blood product transfusion at the time of LVAD implantation and mortality has not been described. Methods and results: This was a retrospective cohort study of all patients who underwent continuous flow LVAD implantation at a single, large, tertiary care, academic centre, from 2008 to 2014. We assessed used of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Outcomes of interest included all-cause mortality and acute right ventricular (RV) failure. Standard regression techniques were used to examine the association between blood product exposure and outcomes of interest. A total of 170 patients were included in this study (mean age: 56.5 ± 15.5 years, 79.4% men). Over a median follow-up period of 11.2 months, for every unit of pRBC transfused, the hazard for mortality increased by 4% [hazard ratio (HR) 1.04; 95% CI 1.02–1.07] and odds for acute RV failure increased by 10% (odds ratio 1.10; 95% CI 1.05–1.16). This association persisted for other blood products including platelets (HR for mortality per unit 1.20; 95% CI 1.08–1.32) and FFP (HR for mortality per unit 1.08; 95% CI 1.04–1.12). The most significant predictor of perioperative blood product exposure was a lower pre-implant haemoglobin. Conclusions: Perioperative blood transfusions among patients undergoing LVAD implantation were associated with a higher risk for all-cause mortality and acute RV failure. Of all blood products, FFP use was associated with worst outcomes. Future studies are needed to evaluate whether pre-implant interventions, such as intravenous iron supplementation, will improve the outcomes of LVAD candidates by decreasing need for transfusions.

Original language	English (US)
Pages (from-to)	3573-3581
Number of pages	9
Journal	ESC Heart Failure
Volume	7
Issue number	6
DOIs	https://doi.org/10.1002/ehf2.12780
State	Published - Dec 2020

Funding

Birati consulted for American Regent, Inc., and received research support from Impulse Dynamics and Medtronic. Goldberg is a consultant for Medtronic and Respircardia. Margulies is in the advisory committees of Novo Nordisk and Astra‐Zeneca and received research grant support from Juventis Therapeutics, Celladon, Thoratec, and Innolign Biomedical. Rame received research grant support from Medtronic and Abbott.

Keywords

Left ventricular assist device
Right ventricular failure
Transfusions

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1002/ehf2.12780

Cite this

Shore, S., Hanff, T. C., Mazurek, J. A., Seigerman, M., Zhang, R., Grandin, E. W., Vorovich, E., Mather, P., Olt, C., Howard, J., Wald, J., Acker, M. A., Goldberg, L. R., Atluri, P., Margulies, K. B., Rame, J. E., & Birati, E. Y. (2020). The effect of transfusion of blood products on ventricular assist device support outcomes. ESC Heart Failure, 7(6), 3573-3581. https://doi.org/10.1002/ehf2.12780

@article{5db430455097483a88340681c805203b,

title = "The effect of transfusion of blood products on ventricular assist device support outcomes",

abstract = "Aims: Perioperative blood transfusions are common among patients undergoing left ventricular assist device (LVAD) implantation. The association between blood product transfusion at the time of LVAD implantation and mortality has not been described. Methods and results: This was a retrospective cohort study of all patients who underwent continuous flow LVAD implantation at a single, large, tertiary care, academic centre, from 2008 to 2014. We assessed used of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Outcomes of interest included all-cause mortality and acute right ventricular (RV) failure. Standard regression techniques were used to examine the association between blood product exposure and outcomes of interest. A total of 170 patients were included in this study (mean age: 56.5 ± 15.5 years, 79.4% men). Over a median follow-up period of 11.2 months, for every unit of pRBC transfused, the hazard for mortality increased by 4% [hazard ratio (HR) 1.04; 95% CI 1.02–1.07] and odds for acute RV failure increased by 10% (odds ratio 1.10; 95% CI 1.05–1.16). This association persisted for other blood products including platelets (HR for mortality per unit 1.20; 95% CI 1.08–1.32) and FFP (HR for mortality per unit 1.08; 95% CI 1.04–1.12). The most significant predictor of perioperative blood product exposure was a lower pre-implant haemoglobin. Conclusions: Perioperative blood transfusions among patients undergoing LVAD implantation were associated with a higher risk for all-cause mortality and acute RV failure. Of all blood products, FFP use was associated with worst outcomes. Future studies are needed to evaluate whether pre-implant interventions, such as intravenous iron supplementation, will improve the outcomes of LVAD candidates by decreasing need for transfusions.",

keywords = "Left ventricular assist device, Right ventricular failure, Transfusions",

author = "Supriya Shore and Hanff, {Thomas C.} and Mazurek, {Jeremy A.} and Matthew Seigerman and Robert Zhang and Grandin, {Edward W.} and Esther Vorovich and Paul Mather and Caroline Olt and Jessica Howard and Joyce Wald and Acker, {Michael A.} and Goldberg, {Lee R.} and Pavan Atluri and Margulies, {Kenneth B.} and Rame, {J. Eduardo} and Birati, {Edo Y.}",

note = "Publisher Copyright: {\textcopyright} 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology",

year = "2020",

month = dec,

doi = "10.1002/ehf2.12780",

language = "English (US)",

volume = "7",

pages = "3573--3581",

journal = "ESC Heart Failure",

issn = "2055-5822",

publisher = "John Wiley and Sons Inc.",

number = "6",

}

Shore, S, Hanff, TC, Mazurek, JA, Seigerman, M, Zhang, R, Grandin, EW, Vorovich, E, Mather, P, Olt, C, Howard, J, Wald, J, Acker, MA, Goldberg, LR, Atluri, P, Margulies, KB, Rame, JE & Birati, EY 2020, 'The effect of transfusion of blood products on ventricular assist device support outcomes', ESC Heart Failure, vol. 7, no. 6, pp. 3573-3581. https://doi.org/10.1002/ehf2.12780

TY - JOUR

T1 - The effect of transfusion of blood products on ventricular assist device support outcomes

AU - Shore, Supriya

AU - Hanff, Thomas C.

AU - Mazurek, Jeremy A.

AU - Seigerman, Matthew

AU - Zhang, Robert

AU - Grandin, Edward W.

AU - Vorovich, Esther

AU - Mather, Paul

AU - Olt, Caroline

AU - Howard, Jessica

AU - Wald, Joyce

AU - Acker, Michael A.

AU - Goldberg, Lee R.

AU - Atluri, Pavan

AU - Margulies, Kenneth B.

AU - Rame, J. Eduardo

AU - Birati, Edo Y.

PY - 2020/12

Y1 - 2020/12

N2 - Aims: Perioperative blood transfusions are common among patients undergoing left ventricular assist device (LVAD) implantation. The association between blood product transfusion at the time of LVAD implantation and mortality has not been described. Methods and results: This was a retrospective cohort study of all patients who underwent continuous flow LVAD implantation at a single, large, tertiary care, academic centre, from 2008 to 2014. We assessed used of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Outcomes of interest included all-cause mortality and acute right ventricular (RV) failure. Standard regression techniques were used to examine the association between blood product exposure and outcomes of interest. A total of 170 patients were included in this study (mean age: 56.5 ± 15.5 years, 79.4% men). Over a median follow-up period of 11.2 months, for every unit of pRBC transfused, the hazard for mortality increased by 4% [hazard ratio (HR) 1.04; 95% CI 1.02–1.07] and odds for acute RV failure increased by 10% (odds ratio 1.10; 95% CI 1.05–1.16). This association persisted for other blood products including platelets (HR for mortality per unit 1.20; 95% CI 1.08–1.32) and FFP (HR for mortality per unit 1.08; 95% CI 1.04–1.12). The most significant predictor of perioperative blood product exposure was a lower pre-implant haemoglobin. Conclusions: Perioperative blood transfusions among patients undergoing LVAD implantation were associated with a higher risk for all-cause mortality and acute RV failure. Of all blood products, FFP use was associated with worst outcomes. Future studies are needed to evaluate whether pre-implant interventions, such as intravenous iron supplementation, will improve the outcomes of LVAD candidates by decreasing need for transfusions.

AB - Aims: Perioperative blood transfusions are common among patients undergoing left ventricular assist device (LVAD) implantation. The association between blood product transfusion at the time of LVAD implantation and mortality has not been described. Methods and results: This was a retrospective cohort study of all patients who underwent continuous flow LVAD implantation at a single, large, tertiary care, academic centre, from 2008 to 2014. We assessed used of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Outcomes of interest included all-cause mortality and acute right ventricular (RV) failure. Standard regression techniques were used to examine the association between blood product exposure and outcomes of interest. A total of 170 patients were included in this study (mean age: 56.5 ± 15.5 years, 79.4% men). Over a median follow-up period of 11.2 months, for every unit of pRBC transfused, the hazard for mortality increased by 4% [hazard ratio (HR) 1.04; 95% CI 1.02–1.07] and odds for acute RV failure increased by 10% (odds ratio 1.10; 95% CI 1.05–1.16). This association persisted for other blood products including platelets (HR for mortality per unit 1.20; 95% CI 1.08–1.32) and FFP (HR for mortality per unit 1.08; 95% CI 1.04–1.12). The most significant predictor of perioperative blood product exposure was a lower pre-implant haemoglobin. Conclusions: Perioperative blood transfusions among patients undergoing LVAD implantation were associated with a higher risk for all-cause mortality and acute RV failure. Of all blood products, FFP use was associated with worst outcomes. Future studies are needed to evaluate whether pre-implant interventions, such as intravenous iron supplementation, will improve the outcomes of LVAD candidates by decreasing need for transfusions.

KW - Left ventricular assist device

KW - Right ventricular failure

KW - Transfusions

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U2 - 10.1002/ehf2.12780

DO - 10.1002/ehf2.12780

M3 - Article

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SN - 2055-5822

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EP - 3581

JO - ESC Heart Failure

JF - ESC Heart Failure

IS - 6

ER -

The effect of transfusion of blood products on ventricular assist device support outcomes

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